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Ask Dr. K: Corticosteroids reduce inflammation of eczema

DEAR DOCTOR K: My 21-month-old daughter has eczema. Is there any way to treat this condition without steroids?

DEAR READER: Eczema, also called atopic dermatitis, is more than just dry skin. It is an inflammatory skin disease that often begins in infancy as an intensely itchy rash. Scratching leads to further irritation. The injured skin becomes chronically inflamed and more vulnerable to infection.

Airborne allergens can make eczema worse. Reducing your daughter’s exposure to these triggers could improve her eczema and reduce her need for treatment:

— Remove carpets and heavy draperies from her sleeping area.

— Wash her bedding frequently in hot water.

— Clean and vacuum frequently.

— Regularly bathe pets and keep them out of her bedroom.

— Avoid foods (such as milk, eggs, soy or wheat) if they trigger your daughter’s eczema.

Skin affected by eczema loses water easily. Keep your daughter’s skin hydrated by soaking it in warm (not hot) baths. Don’t use soaps and shampoos, which worsen dry skin, more than twice a week.

Gently pat (don’t rub) her skin dry with a soft towel. Promptly and generously apply thick moisturizers with a low water content to lock in the moisture. Choose creams without fragrances, dyes or preservatives.

Antihistamines can help to control the ferocious itch, but they can cause drowsiness. Giving your daughter an antihistamine at bedtime may help relieve her itch and help her sleep during an uncomfortable flare-up.

If these measures don’t control your daughter’s eczema, her doctor will likely recommend a topical corticosteroid to apply to her skin.

Corticosteroid creams and ointments effectively reduce inflammation. They are one of the most important types of medicines to be developed in the past 50 years. Eczema is just one of the many diseases and conditions that can be effectively treated by these medicines.

Corticosteroids often are called just “steroids” by doctors. But don’t be confused: These inflammation-fighting hormones are different from the “steroids” that body builders use.

Corticosteroid creams can gradually thin the skin and cause small blood vessels to break if used on the face. So use them with caution, and in low doses, on the face — as directed by your daughter’s doctor.

You may have heard that corticosteroids can stunt a child’s growth and thin the bones. That’s an issue with corticosteroid pills (or injections), but not with corticosteroid creams and ointments — unless extraordinary amounts are used over much of the body.

As with any medicine, corticosteroids have both benefits and risks. You should discuss with your daughter’s doctor what the balance of benefits and risks is likely to be in her case, and I’m sure you’ll be able to find the right treatment. Fortunately, your daughter has available effective treatments that had not yet been developed two generations ago.

Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.

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